Peroneal Artery Perforators

perforantes arteriae fibularis

The peroneal artery gives off multiple septocutaneous and musculocutaneous perforators through the posterior crural intermuscular septum to supply the skin of the posterolateral leg. These perforators emerge through the septum between the flexor hallucis longus and the peroneal muscles approximately 5-7 cm above the lateral malleolus (the most consistent distal perforator group), and again in clusters at the mid-calf and proximal calf levels.

Region: Lower Leg

Clinical Relevance

Clinical Notes

The distal peroneal perforators are the pedicles for the reverse sural artery flap, which rotates the posterior lower leg skin on the distal peroneal perforator-sural artery anastomosis to cover heel, ankle, and lower third of leg defects. Pre-operative Doppler mapping locates the dominant perforator 5-7 cm above the lateral malleolus. The peroneal perforators are also the basis for the perforator-based propeller flaps of the lateral lower leg, allowing local rotation of islanded skin without sacrificing the major peroneal trunk.

Pathology

Common Injuries & Conditions

Reverse Sural Flap Based on Peroneal Perforators

The distal peroneal artery perforators form the proximal pedicle of the reverse sural artery flap; the skin island of the posterior calf rotates 180 degrees on the distal peroneal perforator point to cover heel and lower ankle defects with well-vascularised skin, with Doppler localisation of the perforator 5-7 cm above the lateral malleolus guiding the pivot point placement.